We don’t usually think much about our shoulders until we experience a certain level of discomfort in them. Shoulder pain can be caused by simple activities such as putting a box overhead, brushing hair or reaching behind our back to scratch. Very often I see my clients injuring their shoulder by performing manual labour, playing sports or by repetitive movement.
We are more likely to have problems with our shoulders as we are aging, especially after age 60. This is because the soft tissues surrounding the shoulder tend to degenerate with age.
Shoulder problems are very common. According to the World Health Organization, 9% of all adults in the U.S. reported struggling with chronic shoulder pain.
The pain can come on gradually or abruptly, and it may range from mild to excruciating. In many cases, we can treat our shoulder pain at home, but sometimes it is necessary to use manual therapy like massage, osteopathy or physiotherapy.
Why is Shoulder Complicated Joint?
I do believe that it is important to understand a little bit of shoulder anatomy. As more you will know about its function and structure, the more you will understand why the shoulder joint is the most complicated and fragile joint in our body and why it does not take a lot to get injured.
The shoulder is a ball-and- socket joint that has three main bones: the humerus (long arm bone), the clavicle (collarbone), and the scapula (also known as the shoulder blade).
These bones are cushioned by a layer of cartilage. There are two main joints. The acromioclavicular joint is between the highest part of the scapula and the clavicle. The glenohumeral joint is made up of the top, ball-shaped part of the humerus bone and the outer edge of the scapula. This joint is also known as the shoulder joint.
The shoulder joint is the most mobile joint in the body. It moves the shoulder forward and backward. It also allows the arm to move in a circular motion and to move up and away from the body.
Ligaments
In our shoulder, we have a few important ligaments. Ligaments are soft tissue structures and unlike tendons, they connect from bone to bone. They are fairly short in comparison to tendons but very similar in what they are made of. Ligaments are tough and flexible.
A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid. Thanks to these ligaments, our shoulder gets better stability and prevents it from dislocating.
Tendons
Tendons are thick bands of connective tissue that connect muscle to bone. Tendons are made of collagen and can withstand increased tension. Thanks to the tendon we can provide movement through muscle contraction.
The most important tendons in the shoulder are the long head of the biceps tendon and rotator cuff tendons – supraspinatus, infraspinatus, teres minor, teres major and subscapularis. Among other important tendons belong the pectoralis minor, coracobrachialis and the short head of the biceps. These tendons and muscles of the shoulder provide stability to the shoulder joint in different ranges of motion.
Cartilage & Labrum
You probably know that at the end of all our bones, we have cartilage made of soft connective tissue. Cartilage creates a gliding surface and helps to protect bones and joints.
Injuries to the cartilage occur either with trauma like a strong impact to the joint or wear and tear due to prolong deterioration. Eventually, the cartilage is worn off and the surface of the two ends of the bone are no longer gliding on a smooth surface with movement, but instead grinding together.
Like the meniscus of the knee, we can find a labrum in our shoulder that helps to provide better support and stability. Same as meniscus in our knee, our labrum can be injured as well. Usually when we repeatedly dislocate the shoulder or by repetitive movement like throwing due to the long head of the biceps tendon pulling on the labrum during the acceleration phase of a pitch or throw. Occasionally we can tear the labrum when we fall on an outstretched arm or when a golfer grounds the club on their swing.
Most Common Shoulder Injuries
Most problems in the shoulder involve the muscles, ligaments, and tendons, rather than the bones. As mentioned above, the shoulder’s ball-and-socket joint gives us a great range of motion, but it comes at the expense of stability. Because of that, our shoulder joint can get dislocated more often than any other joint in the body. And stress from repetitive movement at work or sports activities can lead to ligament tears and other injuries.
If you do get shoulder pain, give yourself these questions to determine whether you have injured yourself or not:
- Can you move your arm freely, or is your shoulder too stiff or painful?
- Do you feel your shoulder unstable?
- Is your shoulder strong enough to do the things you usually do?
If in pain, you can treat some shoulder injuries at home with rest and ice for a few days. You can bandage it to provide more stability to prevent movement that causes pain. But some injuries need professional help. However, if you do feel these signs below, it is better to seek out help from healthcare professionals like Manual Osteopaths, Physiotherapists or Chiropractors.
- Every movement is causing pain and discomfort
- The pain is intense and not getting better over a few days
- The shoulder is swollen and you can feel more heat when touching the skin
- Your arm or hand is weak
- You can feel numbness, pins and needles or nerve pain in your shoulder, forearm or fingers
Arthritis
There are 5 types of arthritis and 2 of them are the most common in the general population – Rheumatoid arthritis and osteoarthritis.
With Rheumatoid arthritis, there are chances of inflammation in multiple joints. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.
RA is an autoimmune health condition and may need medications such as corticosteroids and therapy for the treatment such as Osteopathy, Naturopathy or Physiotherapy.RA is equally common in both joints of the shoulder.
On the other hand, Osteoarthritis is the result of constant wear and tear in the cartilages. It is a condition that affects the outer covering of bone. As the articular cartilage wears away, it becomes ough, and the space between bones decreases. During movement, the bones of the joint rub against each other and causes pain. This is often referred to as “bone on bone” arthritis.
Rotator Cuff Tear
Your arm is kept in your shoulder socket by your rotator cuff. A rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
You can damage it through overuse or in a fall. It also begins to show wear and tear as you age. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. However, during an accident, it does not have to always tear completely. Sometimes there can be just partial tears that can be shown only on MRI pictures. Depending on the size of the tear, age and sports activity, surgeons should decide whether you need surgery or whether you should visit healthcare professionals for proper treatment that involves gentle soft tissue release of muscles surrounding rotator cuffs like deltoid muscles, biceps muscles, tricep muscles and strengthening exercises. Both Manual osteopaths and registered Massage Therapists are well trained in treating rotator cuff tears. If recovery takes a long time or Rotator Cuffs cause frozen shoulder, Acupuncture or Trigger Point Injections would be the best alternative treatment for successful recovery.
Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Pain and stiffness usually begin gradually and get worse over time.
If you have a frozen shoulder, you’ll likely feel a dull or achy pain in one shoulder. You might also feel pain in the muscles attaching to the shoulder and around. The pain usually gets worse at night, which can make it difficult to sleep.
Frozen shoulder typically develops slowly, and has 3 stages.
- Freezing stage. Any movement of your shoulder causes pain, and your shoulder range of motion starts to become limited.
- Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
- Thawing stage. The range of motion in your shoulder begins to improve.
.
.People who’ve had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:
- Rotator cuff injury
- Broken arm
- Stroke
- Recovery from surgery
Bursitis
Inside each of your shoulders is a tiny, fluid-filled sac known as a bursa. Bursae help reduce friction between the tendon and joint. If the bursa in your shoulder becomes inflamed, it leads to a condition known as shoulder bursitis. It is a condition usually characterized by pain and sometimes by redness and swelling
There are several ways to get bursitis, but the condition is usually caused by too much stress on the bursa. Causes can include injury, overuse, or medical conditions that cause joint inflammation, such as rheumatoid arthritis.
The shoulder bursa acts as a cushion for a tendon in your rotator cuff that connects bone to bone. If you have bursitis, certain movements of your shoulder and the tendon can cause significant pain and discomfort. The pain can vary based on your specific injury. However, some of the more common symptoms of bursitis are:
- Discomfort when lying on your shoulder
- Pain on the outside or top of your shoulder
- Pain that gets worse when you lift your arm to the side
- Pain when pushing on or opening a door
- Pain when trying to move your arm
Treatment usually involves resting, using ice, inflammatory pain relief, shoulder brace, gentle stretching. Acupuncture can be very effective for decreasing tension in surrounding muscles. Osteopathy can be effective for improving shoulder range of motion. Massage therapy can be also helpful for decreasing muscle tension and improving mobility. Naturopaths can use trigger point injections or prolotherapy to treat injured tendons and to speed up recovery.
Dislocation
The shoulder joint is the most frequently dislocated joint of the body. Because it moves in several directions, your shoulder can dislocate forward, backward or downward, completely or partially, though most dislocations occur through the front of the shoulder. In addition, fibrous tissue that joins the bones of your shoulder can be stretched or torn, often complicating the dislocation.
Dislocation may cause numbness, weakness or tingling near the injury, such as in your neck or down your arm. The muscles in your shoulder may spasm from the disruption, often increasing the intensity of your pain. It is strongly recommended to get medical help for the shoulder that has been dislocated.
A dislocated shoulder may be caused by:
- Sports injuries by contact sport like soccer or ice hockey or by fall during skiing or gymnastic.
- Trauma is not related to sports. A hard blow to your shoulder during a motor vehicle accident is a common source of dislocation.
- You may dislocate your shoulder during a fall from the stairs of the ladder.
If you dislocate your shoulder, you may be prone to cause the same injury again in the future as the ligaments and tendons have been stretched out and become loose. If that happens several times, there is a high risk of damaging ligaments, labrum or nerves. Also, it will cause joint instability.
If you happen to dislocate your shoulder, after the initial assessment and treatment from a medical doctor, you can try these steps to ease discomfort and improve healing: rest your shoulder, combine ice and heat for several minutes, maintain the range of motion of your shoulder by exercises that have been recommended by a health care professional like Osteopathic Practitioners or Physical Therapist.
Key Facts about Shoulder Injuries
1. R.I.C.E
The best treatment for shoulder pain is Rest, Ice, Compression and Elevation. This can help to reduce inflammation and provide pain relief.
2. The earlier you treat your shoulder, the more effective the recovery
Often these injuries can be resolved without surgery. The goals for most shoulder injuries are to decrease inflammation, alleviate pain, strengthen muscles and improve range of motion. As earlier, you seek out professional help, more help and relief you can get.
3. Exercise can help but also hinder your shoulder recovery
To keep Shoulders healthy and injury-free, it is important to maintain stretching and strengthening exercises on regular basis. However, it is important to focus on your technique of shoulder exercises because improper techniques may lead to strains and weakness of the shoulders. Inappropriate weight or movement of the shoulder may strain muscles supporting shoulders such as rotator cuffs, deltoid muscle or biceps tendon. Occasionally, the bad technique can damage the joint capsule or tear the labrum that requires longer rehabilitation.
It is always best to immediately seek medical attention to prevent shoulder injuries from worsening.
4. Shoulder injuries are most often caused by rotator cuff muscles
Rotator cuff tears are the most common cause of shoulder pain. If you happen to have a rotator cuff tear, you have about a 50 % chance to heal through non-surgical treatments like medication, RICE and adequate therapy like Osteopathy, Acupuncture or Massage Therapy. Steroid or trigger point injections may also speed up healing.
5. Shoulder pain can lead to disrupted sleep
Positioning yourself for sleep can be challenging with shoulder pain, with most sleep positions causing severe discomfort leading to sleep disorders. But the wrong position can also cause more pain and in some cases some damages. If experiencing shoulder pain, try to avoid sleeping on the same side as it can increase pressure on the joint and more strain on rotator cuff muscles. When experiencing nerve pain coming from the neck/shoulder, try to sleep on your back, put a pillow on your tummy and rest your hands over the pillow. Supporting the shoulders with small pillows under your shoulders can also decrease pain and strain.
6. Osteoarthritis is more common in people over 50
This may sound a little harsh, but your risk of developing osteoarthritis of the shoulder with its pain and physical limitations increases with age. But an injury, such as a dislocated shoulder, can lead to shoulder osteoarthritis even in young people.
OA most often occurs in people who are over age 50. In younger people, OA can result from an injury or trauma, such as a fractured or dislocated shoulder. This is known as posttraumatic arthritis. Osteoarthritis may also be hereditary.